UMEM Educational Pearls

Title: What's the Diagnosis? Case by Dr. Tu Carol Nguyen

Posted: 1/6/2014 by Haney Mallemat, MD
Click here to contact Haney Mallemat, MD

Question

37 year-old male presents after sustaining a burn from a pot of boiling water. He states that his skin started to blister a few hours after and it’s quite painful. What type of burn does he likely have?

Answer

A non-circumferential, superficial partial-thickness burn; it was treated with Silvadene (silver sulfadiazine)

Burn Classification:

The traditional 1st, 2nd, 3rd degree classification-system was replaced by:
- Superficial: skin is dry, red, and blanches with pressure; painful sensation (e.g. sunburn)
- Superficial partial-thickness: skin has blisters, red, moist, weeping, and blanches with pressure; painful sensation
- Deep partial-thickness: skin has blisters, wet/waxy dry, variable color (patchy to yellow-white to red), and does not blanch with pressure; pressure-like sensation
- Full-thickness: skin is waxy-white to leathery-gray to charred and black; dry, elastic, and does not blanch with pressure; deep-pressure sensation
- Fourth-degree: Burn extends into fascia, muscle, bone; deep-pressure sensation
Always be concerned with extremity burns because they can become edematous, causing superficial/deep partial-thickness to convert to full-thickness burns
Treat with:
- Extremity elevation
- Topical antibiotic creams/ointments
- Blister debridement is controversial
- Observation for compartment syndrome if circumferential
- Consult with burn center as necessary
See image below demonstrating blisters after debridement

References

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Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine). New York: McGraw-Hill Companies. pp. 1374–1386.